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Understanding Long-Acting Opioids

Long-acting opioids are medicines that slowly release opioids into your body, keeping steady amount in your system throughout the day. For that reason, you shouldn’t expect them to provide quick relief of pain in the moment. Instead, they work in the background to prevent pain spikes and to control your overall pain level.

Common examples are MS-Contin, Morphine ER, OxyContin, and fentanyl (Duragesic) patches. To see your long-acting opioid, go to your Medicine Cabinet.

How long do they last?

Each medicine is a little bit different in terms of how long they take to work, and when they wear off:

Always follow the instructions on your prescription bottle.

Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
Take them when you have pain and need quick relief.

These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If you don’t have pain, don’t take them.

If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Take them before your pain gets severe.

Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
Choose the dose that matches your pain level.

Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Take them about 30 minutes before painful activities.

Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
If your short-acting opioid is not working well, talk to your care team.

Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

How to use your long-acting opioids

Take them on a regular schedule, whether or not you feel pain. You may not notice an immediate difference after taking them but keep using them on a regular schedule to help with your overall pain control.

NEVER change the dose of your long-acting opioid on your own. If you feel like your long-acting opioid is too much, or not enough, talk to your care team about whether you need a different dose, or a different medication.

NEVER stop taking your long-acting opioid suddenly. This can cause symptoms of withdrawal, including pain, nausea, diarrhea, sweating, and anxiety. If there is a time that you don’t need your long-acting opioid anymore, your care team can help you come up with a safe plan to taper it.

Pill long-acting opioids

oxycodone (OxyContin), morphine (MS Contin, Morphine ER), or methadone (Dolophine)

Here are some important things to remember about taking long-acting opioids in pill form:

Always follow the instructions on your prescription bottle.

Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
Take them when you have pain and need quick relief.

These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If you don’t have pain, don’t take them.

If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Take them before your pain gets severe.

Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
Choose the dose that matches your pain level.

Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Take them about 30 minutes before painful activities.

Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
If your short-acting opioid is not working well, talk to your care team.

Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

Long-acting opioids are taken on a schedule. Here's some advice about timing your doses:

Always follow the instructions on your prescription bottle.

Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
Take them when you have pain and need quick relief.

These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If you don’t have pain, don’t take them.

If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Take them before your pain gets severe.

Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
Choose the dose that matches your pain level.

Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Take them about 30 minutes before painful activities.

Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
If your short-acting opioid is not working well, talk to your care team.

Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

Patch long-acting opioids

Fentanyl (Duragesic) patch

Fentanyl patches are changed every few days. Look at your prescription box to see if you are supposed to change the patch every 48 hours or every 72 hours:

Always follow the instructions on your prescription bottle.

Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take. For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
Take them when you have pain and need quick relief.

These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If you don’t have pain, don’t take them.

If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Take them before your pain gets severe.

Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
Choose the dose that matches your pain level.

Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed. If your pain is severe, start with the higher dose (for example: 2 tablets). If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Take them about 30 minutes before painful activities.

Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
If your short-acting opioid is not working well, talk to your care team.

Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.

Here are some important tips for using fentanyl patches:

Choose a regular time of day to change your patch (for example, in the morning after waking up)
Write the dates on a calendar, or use this app to remind you when to change your patch
Write the date on your patch (a sharpie works best) whenever you put on a new one. This will help you remember when to change it.

Learning how to properly place and change your fentanyl patch can take time to figure out. Read more here:

Using a Fentanyl Patch

Want to learn more?

Check out these resources:

Opioids: Which One Do I Take?

Video: How Opioids Work